中文摘要：

目的比较急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）、简化急性生理学评分Ⅱ（sAPSⅡ）、急诊脓毒症死亡风险评分（MEDs）对急诊抢救室全身炎症反应综合征（SIRS）患者28d死亡的预测能力。方法选取2006年12月-2007年9月在首都医科大学附属北京朝阳医院急诊抢救室救治的621例SIRS患者，分别进行APACHEⅡ、SAPSI和MEDS评分，记录28d转归情况。通过logistic回归分析评价各评分系统分值与预后的关系，确定SIRS患者28d死亡的独立预测因素，通过受试者工作特征曲线（ROC曲线）对各独立预测因素的预后能力进行比较。结果621例患者28d死亡222例。死亡组患者年龄及3种评分系统的分值均显著高于存活组（年龄：73岁比70岁，APACHEⅡ评分：18分比14分，SAPSI评分：36分比24分，MEDs评分：14分比7分，P〈0．05或P〈0．01）。28d死亡的独立预测因素有APACHEI、SAPSⅡ、MEDS评分，ROC曲线下面积（AUc）分别为0．715、0．774、0．965。与APACHEI评分比较，MEDS评分的预后能力更佳（z-35．435，P〈0．01）。结论对于急诊抢救室SIRS患者，MEDS具有较好的预后价值。

英文摘要：

Objective To evaluate the predictive ability of 3 scoring systems, i.e. acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） score, simplified acute physiology score Ⅱ （SAPS Ⅱ ） and mortality in emergency department sepsis （MEDS） score in patients presenting systemic inflammatory response syndrome （SIRS） in emergency department. Methods Six hundred and twenty-one adult patients with SIRS admitted from December 2006 to September 2007 in the emergency department of Beijing Chaoyang Hospital were eligible for the study. The first 24-hour admission data necessary for the calculation of APACHE Ⅱ score, SAPS Ⅱ score, MEDS score and basic demographic statistics were collected and the outcomes in 28 days were recorded. Logistic regression analysis was used to determine the independent predictors for 28-day mortality. Discrimination of each scoring system was assessed with the areas under the receiver operating characteristics （ROC） curve （AUC）. Results A total of 222 patients died in 28 days in a total of 621 patients. The age and mean levels of 3 scoring systems were predominantly higher in nonsurvivors than survivors （73 years vs. 70 years for age, P〈0.05; 18 vs. 14 for APACHE Ⅱscore, P〈0.01; 36 vs. 24 for SAPS Ⅱ score, P〈0.01; 14 vs. 7 for MEDS score, P〈0.01）. The independent predictors of 28-day mortality were APACHE Ⅱ score, SAPS Ⅱ score and MEDS score. The AUCs were 0. 715, 0. 774 and 0. 965 for APACHE Ⅱ score, SAPS Ⅱ score and MEDS score, respectively. There was significant difference between MEDS score and APACHE I score in AUC （Z=35.435, P〈0.01）. Conclusion In emergency department patients with SIRS, the MEDS score possesses more predictive ability than APACHE Ⅱ score.